How doctors and other clinicians can talk to patients about surprise bills, health costs

social determinants
There's help for doctors who want to talk to patients about healthcare costs. (noipornpan/GettyImages)

As politicians in Washington, D.C., consider a sweeping legislative package aimed at curbing healthcare costs including surprise billing and drug prices, it’s also time that doctors and other clinicians be prepared to address those same issues with their patients.

However, talking about costs isn’t always a conversation that doctors and clinicians—or even some patients—want to have.

Josh Seidman
Josh Seidman (Courtesy Avalere)

But with healthcare costs at the forefront, physicians need to understand why cost conversations are increasingly important and how they fit into a clinician’s role, Josh Seidman, managing director of Avalere Health’s Center for Healthcare Transformation, told FierceHealthcare. 

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As Seidman talked about the research Avalere has done in conjunction with the Robert Wood Johnson Foundation, Senate lawmakers Thursday released a draft package of legislation (PDF) they hope to pass on a bipartisan basis, with bills to eliminate surprise medical bills, reduce drug prices and improve price transparency.

In light of surprise bills, rising premiums and deductibles and increased out-of-pocket spending, more patients are worried about medical expenses. Yet, while research shows that 70% of patients want to have conversations about the costs of care with their doctors, only 28% of them report having those talks, said Seidman.

There are barriers on both sides. Doctors may feel that addressing costs is outside their focus, not have enough time to have those conversations or feel they lack knowledge about costs or won’t have any viable solutions for patients. In turn, patients can feel embarrassed or uncomfortable bringing up costs during a visit.

Despite those reservations, “there’s a lot of value in just trying to initiate these conversations,” said Seidman. Patients need that kind of information.

“In lieu of having these conversations, they are going to make decisions that are going to affect their clinical care. We know a lot of patients are skipping medications or foregoing various treatments because they can’t afford it. Often, they are going to do that without talking to their doctors because they don’t want to admit it or talk about it,” Seidman said.

And while some doctors worry they won’t have time to talk to patients about cost issues, research has found these conversations are fairly brief, he said.

“There is a lot of value in bringing it up. Even a brief conversation can be helpful, and patients aren’t expecting their providers to have all the information. It’s a way to start down that road,” he said.

A doctor may not know the specifics of what a patient’s out-of-pocket costs may be for a medication or treatment but talking about expenses is a way for clinicians to show support for their patients and build trust. “Just expressing concern about it is something that lets patients know their doctors care about them. It helps to build trust. It helps cement the relationship,” he said.

So how can doctors approach these topics with a compassionate and trusting voice? The research found there are specific ways doctors can do that. America’s Essential Hospitals provides some guidance through action briefs published on the organization's website.

The briefs cover topics such as what patients aren’t telling their providers, how to structure cost conversations and how to integrate those conversations into the workflow.

RELATED: Insurer-backed coalition forms to push efforts to stem ‘surprise bills’ 

The research showed that patients are often waiting for their doctors and other clinicians to initiate the conversation about costs. Doctors may have solutions to patients’ cost concerns such as switching to lower-cost alternative therapies or diagnostics to switching from brand name to generic medications.

Particularly with patients who are within vulnerable populations, doctors need to be sensitive to their fears of receiving less effective care, Seidman said.

As for surprise bills, at least there is more attention focused on the problem, he said. Many providers who work closely with vulnerable populations, such as those in federally qualified health centers, have always considered talking to patients about costs as part of their job, he said. They know the level of clinical care their patients are getting is going to be dictated somewhat by costs. It’s not just direct out-of-pocket costs that can be a surprise, but patients and families can face substantial nonmedical costs in trying to access care, such as taking time away from jobs and transportation, Seidman said.

RELATED: Solution to surprise billing should fall to hospitals, insurers—not patients, experts say 

“Doctors often feel like they don’t have all the answers, so they worry either they will not be helpful or get themselves down a rabbit hole. But ignoring it won’t make the problem go away for the patient,” he said.

Over time, the hope is there will be greater transparency and more resources available, he said, as well as better partnerships between health plans and providers so doctors have more information about an individual’s costs of care at the point of care. “Those kinds of things will make a big difference in the future,” Seidman said.

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